December 3, 2015

NMT Metric Consultation

CF Learning presenter, Child Trauma Academy Fellow and Cal Farley’s Senior Administrator of Residential Programs, Michelle Maikoetter, LPC-S, NCC, EAP, EMDR offers an assessment service based Dr. Bruce Perry’s Neurosequential Model of Therapeutics and its associated metric tool.

The metric tool can help inform the work your clinical team and organization does with children, including formulation of recommendations and the creation of targeted interventions.

Below is a description of NMT taken from The Child Trauma Academy.  Please contact us to set up a NMT metric consultation for your organization.

What is NMT?

The Neurosequential Model of Therapeutics (NMT) is a developmentally sensitive, neurobiology-informed approach to clinical problem solving. NMT is not a specific therapeutic technique or intervention. It is an approach that integrates core principles of neurodevelopment and traumatology to inform work with children, families and the communities in which they live. The Neurosequential Approach has three key components – training/capacity building, assessment and then the specific recommendations for the selection and sequencing of therapeutic, educational and enrichment activities that match the needs and strengths of the individual.

The NMT assessment process examines both past and current experience and functioning. A review of the history of adverse experiences and relational health factors helps create an estimate of the timing and severity of developmental risk that may have influenced brain development (see graph).NMT-graph1

In the sample graph, both the timing and severity of risk and resilience factors are plotted (top graph) to generate an overall developmental risk estimate (bottom graph). In this case, this individual was at high risk for developmental disruptions – with potential significant functional consequences – during the entire first five years of life.

A review of current functioning identifies problems and strengths in current functioning and helps generate a visual representation of the child’s estimated current functioning organized into a neurobiological fashion; this generates a Functional Brain Map (see below). The NMT “mapping” process helps identify various areas in the brain that appear to have functional or developmental problems; in turn, this helps guide the selection and sequencing of developmentally sensitive interventions. These interventions are designed to replicate the normal sequence of development beginning with the lowest, most abnormally functioning parts of the brain (e.g., brainstem) and moving sequentially up the brain as improvement is seen. The NMT is grounded in an awareness of the sequential development of the brain; cortical organization and functioning depend upon previous healthy organization and functioning of lower neural networks originating in the brainstem and diencephalon. Therefore a dysregulated individual (child, youth or adult) will have a difficult time benefiting from educational, caregiving and therapeutic efforts targeted at, or requiring, “higher” cortical networks. This sequential approach is respectful of the normal development sequence of both brain development and functional development. Healthy development depends upon a sequential mastery of functions; and a dysregulated individual will be inefficient in mastering any task that requires relational abilities (limbic) and will have a difficult time engaging in more verbal/insight orientated (cortical) therapeutic and educational efforts.

The NMT Web-based Clinical Practice Tools (aka, NMT Metrics) help provide a structured assessment of developmental history of adverse experiences, relational heath and current brain-mediated functioning. These NMT Metrics are designed to complement, not replace, existing assessment tools (e.g., CANS, CAFAS) and psychometrics (e.g., CBCL, IES, WISC, WRAT). They are designed to allow use across multiple systems using multiple assessment packages. The primary goal of the NMT Metrics and assessment is to ensure that the clinical team is organizing the client and family’s data (and planning) in a developmentally sensitive and neurobiology-informed manner.


To the left is an example of a functional brain “map” produced by the web-based NMT Clinical Practice Application. The top image (with the red square) corresponds to a client (each box corresponds to brain functions mediated by a region/system in the brain. The map is color coded with red indicating significant problems; yellow indicates moderate compromise and green, fully organized and functionally capable). The bottom map is a comparative map for a “typical” same-aged child. The graphic representations allow a clinician, teacher, or parent to quickly visualize important aspects of a child’s history and current status. The information is key in designing developmentally appropriate educational, enrichment and therapeutic experiences to help the child.

This clinical approach helps professionals determine the strengths and vulnerabilities of the child and create an individualized intervention, enrichment and educational plan matched to his/her unique needs. The goal is to find a set of therapeutic activities that meet the child’s current needs in various domains of functioning (i.e., social, emotional, cognitive and physical). An individual demonstrating significant problems in brainstem and diencephalic functions may end up with recommended activities that include music, dance, yoga, drumming, various sports, and therapeutic massage to more traditional play therapy, sand tray or other art therapies. Later in the treatment process, after improved brain stem and diencephalic functioning, the treatment recommendations would shift to more insight orientated-and cognitive-behavioral interventions such as PCIT or TF-CBT.